Chapter 13- Skin Flashcards
(127 cards)
1
Q
What do emollients do and when are they indicated
A
Soothe, smooth and hydrate the skin
Indicated for all dry or scaling disorders
2
Q
When are barrier preparations indicated
A
They contain water repellent substances used on: The skin around a stoma Bedsores Pressure areas Nappy rash
3
Q
What’s the MHRA alert for emollients
A
Risk of severe and fatal burns
4
Q
How long should local antifungal infection treatment be carried on for after signs are gone
A
1-2 weeks
5
Q
What antibacterials are mainly used for skin infections
A
Neomycin Metronidazole Polymyxins Silver sulfadiazine Mapirocin
6
Q
Which antifungals are mainly used for skin infections
A
Imidazole: Clotrimazole Econazole Ketoconazole Miconazole Tioconazole
Other:
Amorolfine
Griseofulvin
Terbinafine
7
Q
What’s used for viral skin infection
A
Aciclovir
8
Q
Why might some emollients contain urea
A
To relieve itching and hydrate the skin
9
Q
What steroid is available OTC and from what age
A
Hydrocortisone 1%
Aged 10 +
10
Q
What is scabies caused by
A
Parasites
11
Q
How long can local topical anaesthetics be used for
A
3 days
12
Q
What skin condition should corticosteroids not be used in
A
Acne
Rosacea
13
Q
What drugs can exacerbate psoriasis
A
Lithium Chloroquine Hydroxychloroquine Beta blocker Nsaid ACEI
14
Q
What’s important to caution with the use of oral retinoids (can be used in psoriasis)
A
Avoid pregnancy 1 month before and Atleast 2 years after treatment
15
Q
Counselling point with benzyl peroxide (used for acne)
A
Avoid sunlight
Can stain clothes
16
Q
Which topical antibiotics can be used for acne
A
Tetracycline
Erythromycin
Clindamycin
For 6 months
17
Q
Side effect of retinoids
A
Risk of benign intracranial hypertension Headache Nausea Vomiting Visual disturbances
18
Q
What preparation is mild to moderate acne usually treated with
A
Topical preparations
Benzyl peroxide, topical retinoids or topical antibiotic
19
Q
When is systemic treatment for acne used
A
Moderate to severe acne
Topical not tolerated
Hard to reach the site
20
Q
Long term risk associated with acireitin (retinoid)
A
Skeletal hypertosis
21
Q
Uses of co-cyprindol
A
Contraception
Acne (in women)
22
Q
Drug in roaccutane and drug class
A
Isotretinoin (vit a)
Retinoid
23
Q
Counselling for roaccutane
A
Seek help of psychiatric disorders develop
Avoid wax and laser During treatment and 6 months after
Avoid exposure to UV light
Use emollients form the start (lips too)
Possible nose bleeds and joint pain
24
Q
What are warts caused by and how are they treated
A
HPV- treated by destroying the affected skin
First line: salicylic acid (OTC)
Cryotherapy equally effective but may cause pain and blistering
25
What do the different UV cause
UVA- tanning and long term skin damage
UVB- sunburn
26
How’s hydrogen peroxide used for skin cleaning
Disinfectant and deodorant for wounds
27
How can potassium permanganate be used for skin cleaning
Used for weeping eczema lesions (may stain the skin)
28
What’s used for many preparations of anti perspirant
Aluminium
29
What’s ointments
Greasy preparations form a more occlusive barrier over the skin
The most hydrating for chronic dry skin
30
What are creams
More cosmetically acceptable
Less greasy in comparison to ointments
Dries quicker than ointment so applied more frequently
31
What’s gels
Contains high water content, suitable for scalp and face application
32
What’s lotions
Have a cooling effect, preferred for applying over a large or hairy area
Can sting promenade skin
33
What’s a mild topical corticosteroid used
Hydrocortisone <2.5%
34
What’s a moderate topical corticosteroid used
Clobetasone (Eumovate)
Betamethasone 0.025% (Betnovate)
35
What’s a potent topical corticosteroid used
Betamethasone 0.1% (betnovate)
Hydrocortisone
Momentasone
36
What’s a very potent topical corticosteroid used
Clobetasol (Dermovate)
37
Counselling on how to apply steroids
Apply thinly to the affected area no more than twice a day
Avoid prolonged use especially to the face
Apply emollient first then the steroid cream 30 minutes after for maximum absorption
38
How is rosacea- facial redness treated
Brimonidine
39
What’s does the pregnancy prevention programme include for roaccutane
Exclude pregnancy with Atleast 2 negative tests
Rx valid for only 7 days with a max 30 day supply
Emergency supply can be given with w negative pregnancy test
40
When should roaccutane treatment be started
On the 2nd or 3rd day of me natural cycle
41
What contraception is not suitable when on roaccutane
Progesterone only contraceptives
42
Should antihistamines be given in eczema?
No as eczema is not histamine related
43
First line otc acne medication
Benzoyl peroxide
44
How can you identify psoriasis
Usually raised red patches of dry skin covered with silvery while scales or plaques
Occurs on the elbows knees and scalp
45
What meds can worsen psoriasis
Lithium
BB
ACEi
Anti malarial drugs
46
OTC treatment for dandruff
Ketoconazole 2% (nizoral)
47
What are warts caused by and Treatment of choice for warts
Virus
Salicylic acid
48
Treatment otc for ring worm
Imadazole (miconazole, ketoconazole, clotrimazole)
Terbineafine (over 16)
49
When should fungal nail infections be referred
```
2 or more nails affected
Under 18
Pregnant/ diabetes
Damage to the nail
Bottom of the nail affected
```
50
Treatment of choice otc for fungal nail infection and how long can it take to work
Amolorfine 5%
Can take 6 months
51
How do you treat a boil otc
Magnesium sulphate can draw out the inside
Abx may be needed
Refer to gp
52
What Comorbidity should you usually refer with skin problems
Diabetes due to poor would healing
53
What’s the key treatment in managing eczema
Emollient
If soap is an irritant substitute for an emollient wash
54
What age can topical steroids be sold to the public from
10 and above hydrocortisone
12 and above clobetasone
55
What should not be used in acne and why
Topical steroids
They can increase local hormone effect making the problem worse
56
How can you avoid damaging healthy skin when removing warts and varrucas with salicylic acid
Apply vaseline on the healthy skin
57
Scabies treatment
Permethrin (> 2 months)
or
malathion (>6 months)
One treatment for whole family then repeated after 7 days
58
What’s the only product licensed to treat hair loss
Minoxidil
2% men and women
5% men only
59
What otc treatment should you not used for psoriasis that can be used in eczema
Steroid
60
What’s the duration of treatment for amorolfine
6 months fingernails
| 9-12 months toenails
61
What antihistamine has a license for pruritis
Hydroxyzine
62
What condition presents as a rash, can have blisters is the rash and and has a tingly sensation like pins and needles
Shingles
63
What safety advice should you say to a patient if using a bath emollient?
Makes the skin and surface slippery so care is neededIf paraffin containing, also warn them of the fire risk
64
What are borderline substances?
Regarded as drugs when prescribed in accordance with the advice of the Advisory Committee on Borderline Substances for the clinical conditions listed.
65
The use of aqueous cream as a leave-on emollient may increase the risk of what?
Skin reactions - particularly in eczema
66
Urea is used with other topical agents e.g. corticosteroids. What would be the reason for this?
To enhance penetration of the skin
67
Diluted creams should be used within how many weeks of preparation?
Within 2 weeks
68
Acute impetigo on small areas of the skin is treated with what?If the impetigo is extensive/cream has not worked, what can be used?
Short-term application of fusidic acid Flucloxacillin can be used (clarithromycin is penicillin allergic)
69
Mupirocin ointment/ nasal ointment is used for what resistant bacterial strain?
MRSA
70
What topical antibiotic is used for rosacea?
Metronidazole
71
What is tinea capitis?
Ringworm of the scalp
72
What is tinea corporis?
Ringworm of the body
73
What is tinea cruris?
Fungal infection of groin
74
What is tinea manuum?
Fungal infection of hands
75
What is tinea pedis?
Athlete's foot
76
What is tinea unguium?
Fungal nail
77
When would a combination cream of antifungal and steroid be used?
Fungal infection in the presence of inflammation
78
What is the common name for labial herpes simplex infection?
Cold sore
79
What is 1st line for scabies?What is 2nd line?
Permethrin
| Malathion
80
If a person with scabies lives with other people, what is recommended?
The whole household should be treated at the same time
81
Where should scabies treatment be applied?
The whole body, including scalp, face, neck and ears
| Particular attention should be paid to the webs of fingers and toes, and lotion should be brushed under the end of nails
82
How often is it recommended that the permethrin and malathion is applied and how many times for scabies?
Applied twice to the whole body for the treatment of scabies
| 1 week apart
83
Dimeticone treatment for headlice should be repeated after how many days?
7 days
84
What is the MHRA warning regarding head lice products?
Risk of serious burns if treated hair is exposed to open flames or other sources of ignition
85
How much contact time with the scalp is recommended in head lice lotions and liquid?
8-12 hours or overnight
86
For the treatment of scabies with malathion lotion, after application, how long should it be left until washing off?
24 hours- when hands are washed within this time, this needs to be repeated
87
With how many eczema flare ups a month would you consider a corticosteroid to prevent further flares?
2-3 a month
88
In patients who require a corticosteroid to prevent flare ups, how often is application recommended?
To be applied on 2 consecutive days each week
89
What drug classes can provoke psoriasis?
Lithium, chloroquine and hydroxychloroquine, beta-blockers, NSAIDs, and ACE inhibitors Psoriasis may not be seen until the drug has been taken for weeks or months.
90
What is 1st line for scalp psoriasis?
Tar based shampoo
| Salicylic acid can also be used if there is significant scaling
91
What is first line for plaque psoriasis?
Vitamin D and its analogues
92
What type of drug is acitretin and what skin condition is it used in?
Vitamin A derivative retinoid used in psoriasis
93
The manufacturers of acitretin do not recommend continuous treatment for longer than how many months?
Longer than 6 months
94
Topical corticosteroids should be applied no more than how many times a day?
No more than twice a day (often once a day is sufficient)
95
What information should be included on a topical corticosteroid dispensing label?
Potency
96
Lotriderm contains what?
Betamethasone and clotrimazole
97
What is the difference in storage requirements for Daktacort cream vs ointment?
Cream you store in a fridge, whereas with the ointment you don't
98
What is azelaic acid used for?
Acne
99
Maximum improvement for acne with antibacterial treatment usually occurs after how much time?
4-6 months
100
What is the minimum number of weeks isotretinoin is usually given for in acne?
16 weeks
101
What is the limit of number of days supply for isotretinoin under PPP?
30 days
102
What does SPF 8 mean?
Should enable a person to remain 8 times longer in the sun without burning.
103
For optimum protection, how often should suncream be applied?
Every 2 hours
104
What skin condition is formaldehyde used for?
Warts
105
Should you use corticosteroids in acne and rosacea?
No - can exacerbate these conditions
106
If a patient needs to apply a steroid cream and emollient, how is this done?
Apply emollient then apply steroid 30 minutes after
107
How much roughly is a finger tip unit of cream? (amount of cream from the tip of the finger to the first crease)
500mg
108
What does 1 finger tip unit cover
2 palms
109
Isotretinoin carries the risk of pancreatitis, especially in what case?
If triglycerides are above 9 mmol/L
110
How should Oral thrush be treated?
1) Daktarin (Miconazole) oral gel
2) Nystatin solution
3) Oral fluconazole
111
Urea is often present in many topical agents. What is its action?
Hydrating agent
112
How is Nappy Rash managed?
1) Change Nappy more frequently2) Irritant case: Barrier cream e.g. Sudocreme, Drapolene, Zinc oxide3) Fungal cases: Clotrimazole cream BD- do not use barrier cream till infection settled
113
How are insect bites and stings usually managed?
Antihistamine cream or short course of steroid cream if inflamed. DO NOT use calamine lotion- leaves itchy residues
114
Topical local anaesthetics may be used for burns, wasp stings etc. These should be avoided in young children, and used for max __ days?
max 3 days Creams containing Benzocaine
115
Hydrocortisone is a ___ steroidHydrocortisone + urea is a ____ steroidHydrocortisone Butyrate is a _____ steroid
Mild
Moderate
Potent
116
First line treatment for seborrhoeic dermatitis?
Ketoconazole 2% shampoo
117
What drugs, used for psoriasis and acne, are teratogenic?
Oral Retinoids: IsotretinoinAcitretin Alitretinoin These are similar to VITAMIN A/ RETINOL and this is also contra-indicated in pregnancy!
118
Acetretin is especially teratogenic. When should pregnancy be avoided?
3 days before, every month whilst on it and at least 3 years after
119
When should contraception be used with Isotretinoin?
1 month before and 1 month after (even with topical). Exclude pregnany 3 days before every month during treatment and 5 weeks after
120
Which drugs used for acne may cause Benign Intercranial Hypertension?
Oral Retinoids: IsotretinoinAcitretin Alitretinoin Discontinue if severe headache, nausea, vomiting or visual disturbance occur
121
How should cradle cap in infants be treated?
Olive oil or Arachic oil (nut oil) or coconut oil
122
Preparations for Male pattern baldness include Finasteride and Minoxidil. Can these be prescribed on NHS Rx's?
NO- all preps for male baldness not available on prescription
123
What age can terbinafine- lamisil and lamisil once be sold otc
Lamisil 16+
| Lamisil once 18+
124
When should you return to work with impetigo
48 hours after abx started
125
How long after can you return to work with scarlet fever
24hrs after abx started
| 1-2 weeks if no abx commenced
126
When can people with scabies return to work
After the first treatment
127
What cases of impetigo do you refer
All bullous impetigo
